[MCQs] The Quizzes about Acute Complaints - Part 8 (20 test)

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Acute Complaints-8

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Question 1

A patient is seeing you in follow up after being hospitalized for acute He is concerned about his risk for hepatocellular carcinoma. Which form of viral hepatitis is associated with a clearly increased risk of hepatocellular carcinoma?

A	Hepatitis A virus
B	Hepatitis B virus
C	Hepatitis C virus
D	Hepatitis D virus
E	Hepatitis E virus

Question 1 Explanation:

Hepatitis B infection is clearly associated with an increased risk of developing hepatocellular carcinoma, and has been labeled as having oncogenic properties.

Question 2

You are examining a newborn whose mother has a positive screen for hepatitis B surface Which of the following is true regarding this situation?

A	When acquired early in life, the large majority of those infected with hepatitis B will have chronic disease
B	If the child has a normal immune system, his likelihood of developing chronic disease is small
C	A higher percentage of adults infected with hepatitis B will develop chronic dis- ease as compared with children
D	A high percentage of children acutely infected will develop fulminant liver disease
E	When Hepatitis B is transmitted perinatally, the child generally develops the typical symptoms of acute hepatitis

Question 2 Explanation:

Transmission of Hepatitis B may occur through the transfer of blood or body fluids, but can also occur perinatally (vertical transmission). If the virus is acquired early in life, the infection is silent, but up to 90% of those infected develop chronic disease. Those with a compromised immune system may also develop chronic disease easier than healthy patients. Healthy adults infected have spontaneous resolution more than 95% of the time. As with infection with hepatitis A, a small percentage of those infected will develop fulminant liver disease.

Question 3

One of your patients had unprotected intercourse with a partner later found to have chronic hepatitis In testing your patient, which of the fol- lowing serologic markers would be the first to appear?

A	Hepatitis B surface antigen
B	Hepatitis B core antigen
C	The IgM to the core protein (IgM anti-HBc)
D	Hepatitis B e antigen
E	The IgM to Hepatitis B e antigen

Question 3 Explanation:

Identifying the correct stage of Hepatitis B infection relies heavily on the correct interpretation of serologic markers. The first marker to appear after infection is usually Hepatitis B surface antigen. It may appear prior to the onset of clinical symptoms, and usually disappears in a few weeks as the patient recovers. Hepatitis B core antigen is a protein contained in the inner core of the virion and is not found in the serum. The antibody to the core protein is found early, and persists indefinitely. The hepatitis B e antigen correlates with active replication.

Question 4

You are talking with a patient who recently found out that a coworker has Hepatitis Which of the following is true about hepatitis C?

A	The hepatitis C virus is found in blood
B	The hepatitis C virus is found in semen
C	The hepatitis C virus is found in vaginal secretions
D	The hepatitis C virus is found in breast milk
E	The hepatitis C virus is found in saliva

Question 4 Explanation:

Unlike HBV, the hepatitis C virus has not been found in body fluids other than blood, and the virus is primarily transmitted through exposure to blood and blood products.

Question 5

You are following a patient after an acute hepatitis B His serologies are shown below:

HBsAg: Positive

HBeAg: Positive

IgM anti-HBc: Negative

IgG anti-HBc: Positive

Anti-HBs: Negative

Anti-HBe: Negative

HBV-DNA: Positive

Which term best describes his disease status?

A	Acute infection, early phase
B	Acute infection, recovery phase
C	Chronic infection, replicating virus
D	Chronic infection, nonreplicating virus
E	Previous exposure with immunity

Question 5 Explanation:

The HBsAG positivity in this case indicates either chronic infection or early infection. The negativity of the IgM anti-HBc rules out an early infection. The HBeAg is correlated with replication, as is the HBV DNA.

Question 6

You check serologies on a patient exposed to hepatitis His serolo- gies are shown below:

HBsAg: Negative

HBeAg: Negative

IgM anti-HBc: Negative

IgG anti-HBc: Negative

Anti-HBs: Positive

Anti-HBe: Negative

HBV-DNA: Negative

Which term best describes his disease status?

A	Acute infection, early phase
B	Acute infection, window phase
C	Acute infection, recovery phase
D	Previous exposure with immunity
E	Vaccination

Question 6 Explanation:

The positivity of the anti-HBs indicates either exposure with immunity, recovery phase, or vaccination. Because the IgG anti-HBc is negative, there is no evidence of past exposure or infection.

Question 7

You are following a patient after an acute hepatitis B His serologies are shown below:

HBsAg: Positive
HBeAg: Positive
IgM anti-HBc: Positive
IgG anti-HBc: Negative
Anti-HBs: Negative
Anti-HBe: Negative
HBV-DNA: Positive

Which term best describes his disease status?

A	Acute infection, early phase
B	Acute infection, recovery phase
C	Chronic infection, replicating virus
D	Chronic infection, nonreplicating virus
E	Previous exposure with immunity

Question 7 Explanation:

The HBsAG positivity in this case indicates either chronic infection or early infection. The positivity of the IgM anti-HBc indicates early infection, and is negative in chronic infection. If the patient were in the recovery phase, his HBsAg would be negative.

Question 8

A 59-year-old woman is discussing urinary symptoms with She describes mild loss of urine with sneezing, coughing, and laughing. Which of the following is a normal age-related phenomenon that may predispose elderly patients to incontinence?

A	The frequency of involuntary bladder contractions decreases with age (poten- tially leading to overflow incontinence)
B	Total bladder capacity decreases with age (potentially leading to urge incontinence)
C	Total bladder contractility increases with age (potentially leading to stress incontinence)
D	Elderly patients excrete a larger percentage of fluid earlier in the day (poten- tially leading to overflow incontinence)
E	Elderly women have urogenital atrophy due to decreased estrogen, and thus have increased sensitivity of the internal urethral sphincter (potentially leading to urge incontinence)

Question 8 Explanation:

Contrary to common perception, urinary incontinence is not inevitable with aging. However, many common age-related changes do predispose elderly patients to incontinence. It is important to remember that these changes are found in many healthy, continent elderly persons. Involuntary bladder contractions increase with age. Total bladder contractility decreases with age. Elderly patients excrete a larger percentage of fluid late in the day (increasing nocturia), and urogenital atrophy leads to decreased internal urethral sphincter sensitivity.

Question 9

You are evaluating a 74-year-old woman for the recent onset of incon- She has diabetes, controlled by diet but with recently increasing sugars, and hypertension, controlled with a combination of lisinopril/ hydrochlorothiazide. She has complained of constipation recently, and has not had a bowel movement for 3 days. Microscopic analysis of her urine is positive for bacteria, but she does not report dysuria, urgency, or frequency. Which of the following is least likely to be a secondary cause for her incontinence?

A	Hyperglycemia
B	Diuretic use
C	Constipation
D	Bacteruria
E	Postmenopausal state

Question 9 Explanation:

Asymptomatic bacteruria is common in well elderly, and does not cause incontinence— whereas, a symptomatic infection may. Hyperglycemia can cause secondary incontinence because of polyuria, and continence can be restored by more tightly controlling the pateint’s sugar. Diuretics also may cause secondary incontinence, and may need to be avoided unless necessary. Stool impaction is thought to be a causative factor in up to 10% of patients with incontinence, and disimpaction may restore continence. Atrophic vaginitis may also be causative, and treatment may improve the situation.

Question 10

You are caring for a 42-year-old woman complaining of inconti- She reports often having a strong, often immediate need to void, fol- lowed by an involuntary loss of urine. She says her symptoms develop so suddenly, she often urinates while trying to get to the bathroom. Which of the following best describes the type of incontinence she is experiencing?

A	Functional incontinence
B	Senile incontinence
C	Urge incontinence
D	Stress incontinence
E	Overflow incontinence

Question 10 Explanation:

Urge incontinence is the most common type of incontinence in the elderly. Due to detrusor hyperactivity, patients often complain of a strong urge followed by an involuntary loss of urine. Functional incontinence refers to a limitation that does not allow the patient to void in the bathroom (bed rest, paralysis, severe dementia) and does not generally relate to the urinary tract. Stress incontinence is the loss of urine associated with increased abdominal pressure, and overflow incontinence is incontinence due to overdistention of the bladder. Senile incontinence is a fictional term.

Question 11

You are performing a review of systems on a 36-year-old mother of She carried all children to term, and had five successful vaginal deliv- eries. She reports leakage of a small amount of urine at the same time as she sneezes. Recently, it also occurs with exercise. Which of the following best describes the type of incontinence she is experiencing?

A	Functional incontinence
B	Senile incontinence
C	Urge incontinence
D	Stress incontinence
E	Overflow incontinence

Question 11 Explanation:

Stress incontinence is much more commonly seen in women than in men, and is most often caused by urethral hypermobility resulting from weakness of the pelvic floor musculature. Patients complain of involuntary loss of urine associated with increases in intra-abdominal pressure (when sneezing, coughing, laughing, or exercising). Functional incontinence refers to a limitation that174 Family Medicine does not allow the patient to void in the bathroom (bed rest, paralysis, severe dementia) and does not generally relate to the urinary tract. Urge incontinence is the loss of urine following a strong urge, and overflow incontinence is incontinence due to overdistention of the bladder. Senile incontinence is a fictional term.

Question 12

One of your patients, a 70-year-old man, complains of frequently dribbling urine throughout the On occasion, he loses a large amount of urine without warning. He is otherwise healthy and takes no other med- ications. Based on his profile and symptoms, what term best describes his symptoms?

A	Functional incontinence
B	Senile incontinence
C	Urge incontinence
D	Stress incontinence
E	Overflow incontinence

Question 12 Explanation:

Overflow incontinence is primarily a loss of the ability to empty the bladder, usually due to neurogenic bladder (longstanding diabetes, alcoholism, disk disease) or because of outlet obstruction (prostatic enlargement). Incontinence is usually a frequent or constant leakage of small amount, but occasionally a large amount of urine is lost without warning. Functional incontinence refers to a limitation that does not allow the patient to void in the bathroom (bed rest, paralysis, severe dementia) and does not generally relate to the urinary tract. Stress incontinence is the loss of urine associated with increased abdominal pressure, and urge incontinence is preceded by a strong urge to urinate. Senile incontinence is a fictional term.

Question 13

You are working up a 66-year-old man with You have ruled out secondary causes, and choose to measure the urine left in his bladder after urinating. You calculate this “postvoid” residual as 250 mL. Which of the following is true?

A	Postvoid residual measurement has no place in the workup of incontinence
B	This amount is below what is expected, and leads one to suspect urge incontinence
C	This amount is about average, and is not helpful in determining this patient’s type of incontinence
D	This amount is more than average, but is not helpful in determining this patient’s type of incontinence
E	This amount is more than average, and would lead one to suspect overflow incontinence

Question 13 Explanation:

After ruling out secondary causes of incontinence, a postvoid residual measurement should be taken. This can be done through catheterization or via ultrasound. A postvoid residual less than 50 mL is normal. A postvoid residual greater than 200 mL indicates inadequate bladder emptying and is consistent with overflow incontinence. Between 50 and 200 mL is indeterminate.

Question 14

You are treating a 40-year-old woman for She’d prefer not to use medications, and would like to try pelvic floor strengthening (Kegel) exercises. Which of the following types of incontinence has shown the best response to pelvic floor strengthening exercises?

A	Functional incontinence
B	Stress incontinence
C	Urge incontinence
D	Overflow incontinence
E	Mixed incontinence

Question 14 Explanation:

Kegel exercises are designed to strengthen the pelvic floor musculature. Patients are asked to squeeze the muscles in the genital area as if they were trying to stop the flow of urine from the urethra. They hold this contraction for 10 seconds, and repeat this many times in the day. Patients are then taught to contract these muscles and hold them during situations where incontinence may occur. They are most useful to treat stress incontinence, but may help with mixed incontinence as well. It is not helpful for functional, urge, or overflow incontinence.

Question 15

One of your patients has tried and failed behavioral therapy for He describes a strong urge to urinate, followed by involun- tary loss of urine. Which of the following would be the best medication for him to use?

A	Oxybutynin (Ditropan)
B	Pseudoephedrine (Sudafed)
C	Trimethoprim-sulfamethoxazole (Bactrim, Septra)
D	Finasteride (Proscar)
E	Terazosin (Hytrin

Question 15 Explanation:

Pharmacological therapy is indicated for incontinence if a behavioral approach is ineffective. For urge incontinence, anticholinergic medications are the drugs of choice with oxybutynin (Ditropan) and tolterodine (Detrol) both indicated for symptoms. Pseudoephedrine has been shown to help stress incontinence,Acute Complaints Answers 175 trimethoprim-sulfamethoxazole has been shown to help in the case of prostatitis, and finasteride and terazosin will help frequent voiding caused by prostatic hyperplasia.

Question 16

You are evaluating a 14-year-old female patient whose mother brought her in for Despite the fact that all of her friends have started men- struating, the daughter has not. On examination, she has no breast develop- ment, no axillary or pubic hair, and her pelvic examination reveals normal appearing anatomy. She has not lost weight recently and is not excessively thin. What is the most likely cause of her primary amenorrhea?

A	Gonadal dysgenesis
B	Hypothalamic failure
C	Pituitary failure
D	Polycystic ovarian syndrome
E	Constitutional delay of puberty

Question 16 Explanation:

Primary amenorrhea is defined as the absence of menses at age 16 in the presence of normal secondary sex characteristics, or absence of menses at age 14 in the absence of secondary sex characteristics. It is usually the result of a genetic or anatomic abnormality. Gonadal dysgenesis is the most common cause of primary amenorrhea, responsible for about 50% of the cases. The most well-known type is Turner’s syndrome (45 XO). Hypothalamic failure is often a result of anorexia nervosa, excessive exercise, chronic or systemic illness and severe stress, and results from a suppression of hypothalamic GnRH secretion. Pituitary failure may result from inadequate GnRH stimulation and is often associated with a history of head trauma, shock, infiltrative processes, pituitary adenoma, or craniopharyngioma. These patients will often display deficiency of other pituitary hormones as well. PCOS may cause primary amenorrhea, but is generally associated with normal breast development. Constitutional delay of puberty, although common in boys, is an uncommon cause of amenorrhea in girls, but clinically is very hard to distinguish from other more common causes.

Question 17

You are seeing a 17-year-old patient who began menstruating at age 14, and has been relatively regular since age She made an appointment to be seen today because she stopped having periods 2 months ago. She denies sexual activity. What is the most common cause of secondary amenorrhea?

A	Polycystic ovarian syndrome
B	Functional hypothalamic amenorrhea
C	Pregnancy
D	Hypothyroidism
E	Hyperprolactinemia

Question 17 Explanation:

Pregnancy is the most common cause of secondary amenorrhea, and can even occur in a patient who claims that she has not been sexually active or says that she only has intercourse during “safe” times. Polycyctic ovarian syndrome is common, and is responsible for about 30% of the cases of secondary amenorrhea. It is characterized by androgen excess, and symptoms include irregular or absent menses, hirsuitism, acne, and virilization. Functional hypothalamic amenorrhea is usually a result of anorexia, rapid weight loss, rigorous exercise, or significant emotional stress. Hypothyroidism and hyperprolactinemia can both be associated with secondary amenorrhea, but are less common causes.

Question 18

A 16-year-old woman comes to your office complaining of unpre- dictable menstrual She began her periods at age 14, and they have never been predictable. She denies sexual activity in her lifetime, has no systemic illness, uses no medications regularly, and her physical examina- tion is normal. What is her most likely diagnosis?

A	Pregnancy
B	Ovulatory bleeding
C	Anovulatory bleeding
D	Uterine leiomyoma
E	Endometrial polyposis

Question 18 Explanation:

Anovulatory bleeding is caused by continuous unopposed endometrial estrogen stimulation. Since these patients do not ovulate, progesterone from the corpus luteum is not secreted, the withdrawal from which would normally cause endometrial sloughing. It is the most common cause of dysfunctional uterine bleeding in women younger than 20 years of age, accounting for about 95% of cases. When women are within 2 years of menarche, this is176 Family Medicine especially common, and can be followed expectantly. Alternatively, oral contraceptives can be used to regulate periods. Pregnancy should be ruled out, even in women who deny sexual activity. Ovulatory bleeding due to fluctuations in estrogen and progesterone levels is also a cause of abnormal bleeding, but accounts for only about 10% of cases. Leiomyomas and polyps may cause bleeding, but usually not in this age group.

Question 19

A healthy 60-year-old woman is seeing you to evaluate vaginal bleed- She has not had a menstrual period for approximately 7 years, but 3 months ago noted occasional pink spotting. Since then, it has increased in amount and has become almost continuous. She is currently sexually active with her husband. On examination, she appears well, her pelvic examination is normal, and screens for sexually transmitted infections are negative. What would be your next step?

A	Pelvic ultrasound to evaluate for fibroids
B	Pelvic CT scan to evaluate for pelvic tumor
C	Laparoscopy to evaluate for endometriosis
D	Endometrial biopsy
E	Begin hormone replacement therapy to regulate bleeding

Question 19 Explanation:

If a postmenopausal woman has vaginal bleeding, she needs an endometrial biopsy to rule out endometrial cancer. In fact, this is usually the first step in the evaluation of this problem, after performing the examination and ruling out sexually transmitted infections or anatomic abnormalities. Ultrasound evaluation may be needed, but this would not be the next step in the evaluation of this condition. Contraindications to this procedure include pregnancy, acute infection, PID, or known bleeding disorder (including coumadin use).

Question 20

You are considering treatment for a 19-year-old female patient with primary What should be your first-line therapy?

A	Use of NSAIDs during menses
B	Use of NSAIDs daily
C	Use of opiates during menses
D	Use of a selective serotonin reuptake inhibitor (SSRI) daily
E	Use of combined oral contraceptive pills daily

Question 20 Explanation:

Primary dysmenorrhea is caused by the release of prostaglandin from the endometrium at the time of menstruation. Treatment focuses on the reduction of endometrial prostaglandin production. This can occur either by using medications that inhibit prostaglandin synthesis, or by suppressing ovulation. NSAIDs are generally the first line of therapy, given their favorable risk/benefit ratio and effectiveness. They should be started the day before menstruation, if possible. Daily use of NSAIDs does not increase effectiveness, and is associated with an increase of side effects. While opiate use may help with pain control, it does not inhibit prostaglandin synthesis and may lead to addiction. SSRI therapy is sometimes used for premenstrual dysphoric disorder, but is not a first-line therapy for dysmenorrhea. OCPs can be used and are effective, but are thought of as second-line therapy.

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II. Preview all questions below

1.A patient is seeing you in follow up after being hospitalized for acute He is concerned about his risk for hepatocellular carcinoma. Which form of viral hepatitis is associated with a clearly increased risk of hepatocellular carcinoma?

Hepatitis A virus
Hepatitis B virus
Hepatitis C virus
Hepatitis D virus
Hepatitis E virus

2. You are examining a newborn whose mother has a positive screen for hepatitis B surface Which of the following is true regarding this situation?

When acquired early in life, the large majority of those infected with hepatitis B will have chronic disease
If the child has a normal immune system, his likelihood of developing chronic disease is small
A higher percentage of adults infected with hepatitis B will develop chronic dis- ease as compared with children
A high percentage of children acutely infected will develop fulminant liver disease
When Hepatitis B is transmitted perinatally, the child generally develops the typical symptoms of acute hepatitis

3. One of your patients had unprotected intercourse with a partner later found to have chronic hepatitis In testing your patient, which of the fol- lowing serologic markers would be the first to appear?

Hepatitis B surface antigen
Hepatitis B core antigen
The IgM to the core protein (IgM anti-HBc)
Hepatitis B e antigen
The IgM to Hepatitis B e antigen

4. You are talking with a patient who recently found out that a coworker has Hepatitis Which of the following is true about hepatitis C?

The hepatitis C virus is found in blood
The hepatitis C virus is found in semen
The hepatitis C virus is found in vaginal secretions
The hepatitis C virus is found in breast milk
The hepatitis C virus is found in saliva

5. You are following a patient after an acute hepatitis B His serologies are shown below:

HBsAg: Positive

HBeAg: Positive

IgM anti-HBc: Negative

IgG anti-HBc: Positive

Anti-HBs: Negative

Anti-HBe: Negative

HBV-DNA: Positive

Which term best describes his disease status?

Acute infection, early phase
Acute infection, recovery phase
Chronic infection, replicating virus
Chronic infection, nonreplicating virus
Previous exposure with immunity

6. You check serologies on a patient exposed to hepatitis His serolo- gies are shown below:

HBsAg: Negative
HBeAg: Negative
IgM anti-HBc: Negative
IgG anti-HBc: Negative
Anti-HBs: Positive
Anti-HBe: Negative
HBV-DNA: Negative

Which term best describes his disease status?

Acute infection, early phase
Acute infection, window phase
Acute infection, recovery phase
Previous exposure with immunity
Vaccination

7. You are following a patient after an acute hepatitis B His serologies are shown below:

HBsAg: Positive
HBeAg: Positive
IgM anti-HBc: Positive
IgG anti-HBc: Negative
Anti-HBs: Negative
Anti-HBe: Negative
HBV-DNA: Positive

Which term best describes his disease status?

Acute infection, early phase
Acute infection, recovery phase
Chronic infection, replicating virus
Chronic infection, nonreplicating virus
Previous exposure with immunity

8. A 59-year-old woman is discussing urinary symptoms with She describes mild loss of urine with sneezing, coughing, and laughing. Which of the following is a normal age-related phenomenon that may predispose elderly patients to incontinence?

The frequency of involuntary bladder contractions decreases with age (poten- tially leading to overflow incontinence)
Total bladder capacity decreases with age (potentially leading to urge incontinence)
Total bladder contractility increases with age (potentially leading to stress incontinence)
Elderly patients excrete a larger percentage of fluid earlier in the day (poten- tially leading to overflow incontinence)
Elderly women have urogenital atrophy due to decreased estrogen, and thus have increased sensitivity of the internal urethral sphincter (potentially leading to urge incontinence)

9. You are evaluating a 74-year-old woman for the recent onset of incon- She has diabetes, controlled by diet but with recently increasing sugars, and hypertension, controlled with a combination of lisinopril/ hydrochlorothiazide. She has complained of constipation recently, and has not had a bowel movement for 3 days. Microscopic analysis of her urine is positive for bacteria, but she does not report dysuria, urgency, or frequency. Which of the following is least likely to be a secondary cause for her incontinence?

Hyperglycemia
Diuretic use
Constipation
Bacteruria
Postmenopausal state

10. You are caring for a 42-year-old woman complaining of inconti- She reports often having a strong, often immediate need to void, fol- lowed by an involuntary loss of urine. She says her symptoms develop so suddenly, she often urinates while trying to get to the bathroom. Which of the following best describes the type of incontinence she is experiencing?

Functional incontinence
Senile incontinence
Urge incontinence
Stress incontinence
Overflow incontinence

11. You are performing a review of systems on a 36-year-old mother of She carried all children to term, and had five successful vaginal deliv- eries. She reports leakage of a small amount of urine at the same time as she sneezes. Recently, it also occurs with exercise. Which of the following best describes the type of incontinence she is experiencing?

Functional incontinence
Senile incontinence
Urge incontinence
Stress incontinence
Overflow incontinence

12. One of your patients, a 70-year-old man, complains of frequently dribbling urine throughout the On occasion, he loses a large amount of urine without warning. He is otherwise healthy and takes no other med- ications. Based on his profile and symptoms, what term best describes his symptoms?

Functional incontinence
Senile incontinence
Urge incontinence
Stress incontinence
Overflow incontinence

13. You are working up a 66-year-old man with You have ruled out secondary causes, and choose to measure the urine left in his bladder after urinating. You calculate this “postvoid” residual as 250 mL. Which of the following is true?

Postvoid residual measurement has no place in the workup of incontinence
This amount is below what is expected, and leads one to suspect urge incontinence
This amount is about average, and is not helpful in determining this patient’s type of incontinence
This amount is more than average, but is not helpful in determining this patient’s type of incontinence
This amount is more than average, and would lead one to suspect overflow incontinence

14. You are treating a 40-year-old woman for She’d prefer not to use medications, and would like to try pelvic floor strengthening (Kegel) exercises. Which of the following types of incontinence has shown the best response to pelvic floor strengthening exercises?

Functional incontinence
Stress incontinence
Urge incontinence
Overflow incontinence
Mixed incontinence

15. One of your patients has tried and failed behavioral therapy for He describes a strong urge to urinate, followed by involun- tary loss of urine. Which of the following would be the best medication for him to use?

Oxybutynin (Ditropan)
Pseudoephedrine (Sudafed)
Trimethoprim-sulfamethoxazole (Bactrim, Septra)
Finasteride (Proscar)
Terazosin (Hytrin)

16. You are evaluating a 14-year-old female patient whose mother brought her in for Despite the fact that all of her friends have started men- struating, the daughter has not. On examination, she has no breast develop- ment, no axillary or pubic hair, and her pelvic examination reveals normal appearing anatomy. She has not lost weight recently and is not excessively thin. What is the most likely cause of her primary amenorrhea?

Gonadal dysgenesis
Hypothalamic failure
Pituitary failure
Polycystic ovarian syndrome
Constitutional delay of puberty

17. You are seeing a 17-year-old patient who began menstruating at age 14, and has been relatively regular since age She made an appointment to be seen today because she stopped having periods 2 months ago. She denies sexual activity. What is the most common cause of secondary amenorrhea?

Polycystic ovarian syndrome
Functional hypothalamic amenorrhea
Pregnancy
Hypothyroidism
Hyperprolactinemia

18. A 16-year-old woman comes to your office complaining of unpre- dictable menstrual She began her periods at age 14, and they have never been predictable. She denies sexual activity in her lifetime, has no systemic illness, uses no medications regularly, and her physical examina- tion is normal. What is her most likely diagnosis?

Pregnancy
Ovulatory bleeding
Anovulatory bleeding
Uterine leiomyoma
Endometrial polyposis

19. A healthy 60-year-old woman is seeing you to evaluate vaginal bleed- She has not had a menstrual period for approximately 7 years, but 3 months ago noted occasional pink spotting. Since then, it has increased in amount and has become almost continuous. She is currently sexually active with her husband. On examination, she appears well, her pelvic examination is normal, and screens for sexually transmitted infections are negative. What would be your next step?

Pelvic ultrasound to evaluate for fibroids
Pelvic CT scan to evaluate for pelvic tumor
Laparoscopy to evaluate for endometriosis
Endometrial biopsy
Begin hormone replacement therapy to regulate bleeding

20. You are considering treatment for a 19-year-old female patient with primary What should be your first-line therapy?

Use of NSAIDs during menses
Use of NSAIDs daily
Use of opiates during menses
Use of a selective serotonin reuptake inhibitor (SSRI) daily
Use of combined oral contraceptive pills daily

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[MCQs] The Quizzes about Acute Complaints – Part 8 (20 test)

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Acute Complaints-8

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